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Weight Assessment

Please ensure you enter accurate height and weight details as this may affect future prescribing decisions

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Your BMI:

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About You

About Your Health

  • Any serious condition which may require immediate hospitalisation
  • Chronic malabsorption syndrome
  • Eating disorders
  • Liver problems
  • Pancreas problems
  • Gall bladder problems
  • Type 1 diabetes
  • Thyroid cancer
  • Asthma
  • Chronic back pain
  • Fatty liver disease
  • Gout
  • Heart disease
  • High cholesterol
  • Osteoarthritis
  • Polycystic Ovarian Syndrome (PCOS)
  • Sleep apnoea

About Your Medications

About Your Agreement

  • You have answered the above questions accurately and honestly.
  • You have capacity to understand all about the condition and the treatments available here.
  • The treatment for your own use only.
  • You have read and understood what the treatment options / benefits / risks and side effects associated with them.
  • You agree to read the patient information leaflet before taking the treatment and use the treatment as directed.
  • You will contact your doctor if you experience any adverse effects or symptoms change.
  • You allow our clinicians to access your NHS (GP) Summary Care Records if required and applicable.
  • You understand there may be an increased risk of pancreatitis / gall bladder problems / gall stones with using the weight loss injectable treatments so if you experience any abdominal pain whilst using them you should consult your doctor.
  • You understand that if you are a woman of childbearing potential you should use effective contraception during and for at least 2 months after stopping weight loss injectable treatments.
  • You agree that in order to obtain the best weight loss results it important to incorporate a healthy balanced diet and exercise with the treatment.
  • You agree to send photographic evidence upon request to verify your weight status.

GP Consent